LEAKED Health Board documents have again thrown the future of Pembrokeshire’s Withybush Hospital into doubt, the Western Telegraph can exclusively reveal.

Hywel Dda University Health Board has announced that it is preparing to go out to consultation later this year on wide-ranging health service changes, but has not made public the options currently being considered.

But the Western Telegraph has obtained documents outlining the nine options that are on the table.

A number of these options see Pembrokeshire stripped of its hospital entirely or lose its Accident and Emergency department.

Others see planned surgery at Withybush, a reliance on ‘community hubs with beds’ or even a new hospital to replace Withybush and Glangwili at an unspecified location.

Readers will remember that a ‘super hospital’ planned for near Whitland was previously touted, and widely rejected, as an option in 2006.

The options are outlined below, but currently remain vague and low on detail.

The options include what is described as 24/7 urgent care and four community hubs with ‘location optimised according to need’.

This would see medical beds at Bronglais General Hospital and Prince Philip Hospital, intensive care unit and minor injuries unit as well as a planned care facility at Glangwili.

This option would see Withybush hospital closed and replaced with the four community hubs and urgent care facility.

Community hospital sites will either maintain beds, become an administrative base or close according to need.

Another would have a rural district general hospital at Bronglais with a minor injuries unit and separate planned care facility, with a planned care facilities at Withybush and Prince Philip.

This would see Glangwili close and replaced by 24/7 urgent care and seven community hubs.

A third option would see all hospitals closed and the building of a tertiary specialist centre. This option, as with all featured, include a rural district general hospital at Bronglais.

The fourth option would see seven 24/7 community hubs plus urgent care at Glangwili, planned care at Withybush and a rural district general hospital at Bronglais along with specialist rehabilitation at Llanelli.

A similar fifth option includes the same number of 24/7 community hubs but with urgent care at Withybush and planned care at Glangwili.

Another plan on the ‘long-list’ of health board proposals would see Withybush and Prince Philip closed and replaced with seven community hubs, some to have beds, and urgent and emergency care at Glangwili.

The seventh option would see 24/7 urgent and emergency provision at Withybush Hospital with Glangwili and Prince Philip replaced with planned care facilities and seven community hubs, some with beds.

The second option to see all hospitals closed would see them replaced with a major urgent and planned care hospital, separate but on the same site, but the location is not shown. There would also be seven community hubs, some with 48 hour observation beds and providing frailty and dementia services.

And in the final option discussed, a major urgent and planned care hospital would result in the closure of Withybush and Glangwili with acute medicine and minor injuries unit at Prince Philip and two community hubs.

The options were produced following engagement events in the summer as part of the transforming clinical services programme.

Releasing details of the forthcoming consultation last week, a health board statement said: “All potential options, which are clinically-led, consider significant change to the status quo and focus on improving the health of the local population and transferring more hospital services into the community where appropriate. Some consider whether hospitals need to take on different roles, or even need to be replaced.

“A fewer number of preferred options will be released publically in the spring, when the Health Board is confident they are viable, safe and an improvement on what is currently provided.”

Medical Director Dr Philip Kloer said: “A number of our services are fragile and dependent on significant numbers of temporary staff, which can lead to poorer quality care. For us specifically in Hywel Dda, the geography we cover is large, with many scattered communities that are getting older, needing more holistic health and social care treatment and support. Because of this, we need to better resource our community based care, which is where most of our patient contact is, and help people manage their health conditions. We also need to evolve traditional ways of working and provide a more proactive approach.

“This will mean changing hospital-based care, as well as community care, and we appreciate the attachment local people and our own staff have for their local hospitals. They have been cared for in them, or work in them, and they also play an important role in our wider communities. The options may propose change to a local hospital; however this is about more than the buildings. This is about investing in our communities, attracting doctors, nurses and therapists by operating a modern healthcare system and keeping hospitals for those who really need hospital care.

“We will not put in place any change that isn’t safe for our patients and population. And we will look at all the impacts from ensuring services are safer with better patient outcomes, to considering the wider impact on people, including the most vulnerable.”

Initial engagement with the public started with the Big Conversation in the summer of 2017, with public workshops and drop-ins held across the three counties of Carmarthenshire, Ceredigion and Pembrokeshire.

Those views have been independently analysed and used as a basis to explore, challenge and test different scenarios, which just since Christmas has resulted in 14 additional events attended by more than 350 people.

Dr Kloer said: “The potential options are evolving, with changes to them on almost a daily basis. Many will never even reach public consultation, for a variety of reasons including safety, accessibility and affordability, or will change significantly as they are tested against population needs and healthcare standards.

“We will be coming back to the public in the spring with fewer options that have been more rigorously tested and we will open and honest about what we think our preferred option is and why. We would not, and cannot, propose something that would not be safe for our population.”

A spokesman added: "The final options are not yet ready. We are currently in the process of assessing, testing, refining and narrowing down potential options and we cannot yet confidently say to the public ‘these are the options and we believe them to be viable, safe and offer an improvement to what we already have’. We should be in that position by the spring and then we will come back out to the public for a formal consultation so they can let us have their views.

"We have taken an open and inclusive approach, allowing a wide range of people – staff, partners, patient representatives - to challenge our thinking and be involved beyond the engagement phase (which was held in the summer 2017) and into option development. This is fairly unusual but we’ve taken this approach to co-produce this consultation at every stage possible. We understand this will stimulate debate and speculation in the community as people want to know right now what this might mean for their community based healthcare or their local hospital, but we believe this has been the right thing to do to really take people with us and involve as many people as possible."No preferred option has yet been determined and the health board has not signed off or agreed to any change at this stage.

Hywel Dda Health Board has produced an animation about the upcoming consultation which can be seen here.